Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
World J Gastroenterol. 2019 Aug 21;25(31):4502-4511. doi: 10.3748/wjg.v25.i31.4502.
As one effective treatment for lateral pelvic lymph node (LPLN) metastasis (LPNM), laparoscopic LPLN dissection (LPND) is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery. With regard to improving the accuracy and completeness of LPND as well as safety, we tried an innovative method using indocyanine green (ICG) visualized with a near-infrared (NIR) camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.
To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.
A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision (TME) and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group. Clinical characteristics, operative outcomes, pathological outcomes, and postoperative complication information were compared and analysed between the two groups.
Compared to the non-ICG group, the ICG group had significantly lower intraoperative blood loss (55.8 ± 37.5 mL 108.0 ± 52.7 mL, = 0.003) and a significantly larger number of LPLNs harvested (11.5 ± 5.9 7.1 ± 4.8, = 0.017). The LPLNs of two patients in the non-IVG group were residual during LPND. In addition, no significant difference was found in terms of LPND, LPNM, operative time, conversion to laparotomy, preoperative complication, or hospital stay ( > 0.05).
ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.
作为治疗侧盆淋巴结（LPLN）转移（LPNM）的有效方法之一，腹腔镜 LPLN 解剖（LPND）由于盆侧壁的复杂解剖结构和手术后的各种并发症而受到限制。为了提高 LPND 的准确性和完整性以及安全性，我们尝试使用吲哚菁绿（ICG）结合近红外（NIR）摄像系统引导中低位直肠癌患者 LPLN 的检测，这是一种创新的方法。
探讨 ICG 增强 NIR 荧光引导成像技术是否是直肠癌患者 LPND 的更好方法。
回顾性分析 2017 年 10 月至 2019 年 3 月我院收治的 42 例经直肠系膜全切除术（TME）和 LPND 治疗的中低位直肠癌伴临床 LPNM 患者的临床资料，将患者分为 ICG 组和非 ICG 组。比较两组患者的临床特征、手术结果、病理结果和术后并发症。
与非 ICG 组相比，ICG 组术中出血量明显减少（55.8 ± 37.5 mL 比 108.0 ± 52.7 mL， = 0.003），LPN 清扫淋巴结数明显增多（11.5 ± 5.9 个比 7.1 ± 4.8 个， = 0.017）。非 ICG 组 2 例患者在 LPND 时 LPLN 残留。此外，两组患者的 LPND、LPNM、手术时间、中转开腹、术前并发症和住院时间差异均无统计学意义（ > 0.05）。
ICG 增强 NIR 荧光引导成像技术是一种可行且方便的 LPND 引导技术，因为它可以在手术的准确性和完整性以及安全性方面带来特殊优势。
